Long-term follow-up of chemoimmunotherapy with rituximab, oxaliplatin, cytosine arabinoside, dexamethasone (ROAD) in patients with relapsed CD20+ B-cell non-Hodgkin lymphoma: Results of a study of the Mayo Clinic Cancer Center Research Consortium (MCCRC) MC0485 now known as academic and community cancer research united (ACCRU).

Abstract

Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-based chemoimmunotherapy regimens in preparation for autologous stem cell transplant. We sought to reduce toxicity and maintain efficacy by using oxaliplatin with rituximab, cytarabine and dexamethasone (ROAD) in a phase II clinical trial in patients who had relapsed after one prior regimen. ROAD was delivered q21 days and consisted of rituximab 375 mg/m2 IV weekly x 4 doses (cycle 1 only); dexamethasone 40 mg PO/IV d2 - 5; oxaliplatin 130 mg/m2 IV day 2; cytarabine 2000 mg/m2 IV × two doses on days 2 to 3; and pegfilgrastim 6 mg SC on day 4. Forty-five eligible patients were accrued between 2006 and 2008. Patient characteristics were a median age of 69 years; 96% had received prior rituximab; 53% were within one year of diagnosis. The median number of cycles received was 2 (range, 1-6). Forty-four % received ROAD as an outpatient. The overall response rate was 71% with 27% (12/45) CR and 44% (20/45) PR. Forty-four % (20/45) of all patients and 69% (18/26) of patients whom responded after 2 cycles proceeded to transplant. Median overall survival was 26 mos (95% CI: 7.3 mos-not reached) and median progression-free survival was 11 mos (95% CI: 6-104 mos). There was no grade 3/4 nephrotoxicity; the rate of grade 3/4 neuropathy was 4%. Forty-two percent of all patients and 69% of patients transplanted remain alive at 5 years. ROAD represents an acceptable salvage therapeutic option for patients with relapsed aggressive NHL.

• Authors: Thomas E Witzig, Patrick B Johnston, Betsy R LaPlant, Paul J Kurtin, Levi D Pederson, Dennis F Moore Jr, Nassim H Nabbout, Daniel A Nikcevich, Kendrith M Rowland, Axel Grothey
• Journal: American journal of hematology (Am J Hematol) Vol. 92 Issue 10 Pg. 1004-1010 (Oct 2017) ISSN: 1096-8652 [Electronic] United States
• PMID: 28614905 (Publication Type: Clinical Trial, Phase II, Journal Article)
• Copyright: © 2017 Wiley Periodicals, Inc.

Chemical References

• Antigens, CD20
• Organoplatinum Compounds
• Recombinant Proteins
• Cytarabine
• Oxaliplatin
• Granulocyte Colony-Stimulating Factor
• pegfilgrastim
• Polyethylene Glycols
• Rituximab
• Dexamethasone
• Filgrastim

Topics

• Aged
• Antigens, CD20 (immunology)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Cytarabine (administration & dosage, adverse effects, therapeutic use)
• Dexamethasone (administration & dosage, adverse effects, therapeutic use)
• Disease-Free Survival
• Drug Administration Schedule
• Drug-Related Side Effects and Adverse Reactions (epidemiology, etiology)
• Female
• Filgrastim
• Follow-Up Studies
• Granulocyte Colony-Stimulating Factor (administration & dosage, adverse effects, therapeutic use)
• Humans
• Kaplan-Meier Estimate
• Lymphoma, B-Cell (drug therapy, immunology, mortality, pathology)
• Male
• Organoplatinum Compounds (administration & dosage, adverse effects, therapeutic use)
• Oxaliplatin
• Polyethylene Glycols
• Recombinant Proteins (administration & dosage, adverse effects, therapeutic use)
• Rituximab (administration & dosage, adverse effects, therapeutic use)